| Background:Intracranial atherosclerotic disease(ICAD)is one of the main causes of ischemic stroke worldwide,and it is of great clinical significance to accurately assess and effectively treat ICAD.Traditional imaging techniques for assessing ICAD are plaque detection methods based on luminal stenosis definition,which cannot fully capture the risk of vascular events.High-resolution vessal wall magnetic resonance imaging(HR-MRI)is a sensitive technique for pathological imaging of vessel wall,which can directly display the intracranial artery wall and describe the imaging characteristics of vulnerable plaques,such as burden and plaque enhancement,to verify plaque stability and evaluate drug efficacy.The effect of statins in stabilizing symptomatic atherosclerotic plaques and preventing their rupture has been demonstrated in coronary and extracranial carotid arteries,but there are few studies on intracranial arteries.Objective:In this study,HR-MRI was used to monitor the dynamic evolution of intracranial vulnerable plaque under long-term statin treatment so as to explore the efficacy of statins on vulnerable plaque,and provide more reference and theoretical basis for the application value of HR-MRI in evaluating intracranial atherosclerosis in clinical practice.At the same time,by identifying surrogate endpoints,it provides more precise information on future risks associated with ICAD,so as to develop individualized treatment plans.Materials and Methods : Patients admitted to the Department of Neurology of the Second Hospital of Dalian Medical University for acute intracranial atherosclerotic stroke from January 2017 to December 2019 were selected.The basic characteristics of the study participants were collected on the day of first onset of admission,and their fasting venous blood was drawn on the second day of admission for the analysis of the following indicators: blood lipids(total cholesterol,triglycerides,high density lipoprotein,low density lipoprotein),blood glucose(fasting blood glucose,glycosylated hemoglobin),erythrocyte sedimentation rate,hypersensitive C-reactive protein,homocysteine.Meanwhile,patients were completed routine cranial MRI sequences(T1WI,T2 WI,T2-FLAIR and DWI),head and neck MRA and HR-MRI within one week of onset.All patients were followed up for 3 years on the premise of regular atorvastatin treatment(40mg in acute phase and 20 mg in secondary prevention).The follow-up time points were 6 months,1 year and 3 years.The above laboratory and imaging examinations were performed at each time point,and drug-related adverse reactions were recorded.The images were uploaded to the PACS workstation to evaluate the signal intensity and morphological characteristics of plaques.The main evaluation indicators included plaque size,plaque burden,thickening mode,vascular remodeling mode,vascular stenosis rate,plaque enhancement rate and degree of enhancement,and further analyzed the dynamic changes of signal intensity and burden of vulnerable plaques under long-term statin treatment.Results: Eventually 19 patients completed follow-up.The average age of enrolled patients was(57.2 ± 9.1)years,and 12 cases(63.2%)were male.According to statistics,compared with the initial onset,after 3 years of taking statins regular,there were significant differences in total cholesterol,triglycerides,low-density lipoprotein,hypersensitive C-reactive protein and erythrocyte sedimentation rate(P<0.05).There were no significant differences in high density lipoprotein,fasting blood glucose,glycosylated hemoglobin and homocysteine(P>0.05).No significant elevation in the levels of transaminase and creatine kinase was observed in statin-related adverse effects.A total of 53 intracranial vulnerable plaques were found in the initial HR-MRI images of the enrolled patients,including 19 culprit lesions,12 probably culprit lesions,and 22 nonculprit lesions.Overall,there were no significant changes in plaque size,plaque burden,stenosis rate,enhancement rate and enhancement grade of all vulnerable plaques after 6 months of statin treatment.There was a downward trend at 1 year,but the difference was not statistically significant(P>0.05),and it was significantly decreased at 3 years,with statistical significance(P < 0.05).There was no statistical difference in the remodeling mode and thickening mode at the three time points(P >0.05).The longitudinal comparison of the culprit lesions individually showed that the plaque size,plaque burden,stenosis rate,enhancement rate and enhancement grade were significantly different from those of the initial onset after 3 years’ statin administration(P < 0.05),and there was no significant change at other time points(P >0.05).There was no significant difference between thickening mode and remodeling mode before and after statin administration(P > 0.05).The longitudinal comparison of the probably culprit lesions and nonculprit lesions together showed that the plaque size,plaque burden and stenosis rate were significantly reduced compared with baseline after3 years of statin taking(P < 0.05).There were no significant differences in the enhancement rate,enhancement grade,thickening pattern and remodeling pattern before and after treatment(P > 0.05).Conclusions:1.Long-term statin treatment can significantly reduce the degree of enhancement and atherosclerotic burden of intracranial vulnerable plaques,so that the plaque can tend to be stable,and even reverse the plaque,especially when the treatment time is more than 3years,indicating the importance of long-term statins treatment for stabilizing vulnerable plaque.2.The plaques of culprit lesions,probably culprit lesions,and nonculprit lesions can be effectively reversed under long-term statin treatment.3.Long-term statin treatment can reduce the level of inflammatory markers and reduce the inflammatory response.4.In clinical practice,HR-MRI can be used to monitor plaque vulnerability and outcomes after treatment using plaque enhancement as an imaging monitoring window to predict the risk of future cerebrovascular events for the purpose of primary prevention. |
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